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Intake &Approval Sheet (FOR PERMIT STAFF ONLY) PERMIT# Wct O( ----00.- <br /> BUILDING <br /> "-O3BUILDING PLANNING <br /> Intake OK by: Date: Intake OK by: Date: \..QYS, ZO\O <br /> Intake Comments: 0). <br /> Inttaake Comments: Assign To: <br /> C.`v YSLQ-��❑ Route to Commercial Building ►'-+ Attach to Project No. \C' v:\- oo\ <br /> ❑ Route to Residential Building ® Route to Historic Reviewer <br /> 0 Make this a"W" Permit 0 OK to Route to Other Departments <br /> Bldg/TI/Addn/Rem Size /6v 0 Hold in Planning File Drawer <br /> Garage/Accessory Struct.Size i y/� Zone <br /> Number of Stories Z- Overlay/Agreement c,C&A 1 \-\ <br /> Basement ❑No ®Yes ZEJI/Unfin Nonresidential Use <br /> Type of Construction i//3 Residential Use t\- i <br /> Occupancy Group f Z Proposed No. of Dwelling Units: <br /> Occupancy Load /6 Total No. of Dwelling Units: SVC (lA) <br /> Fire Sprinklers: ❑Update Existing ❑New System PtNot Req'd Planning/Landscape Inspection Required before Final? ❑Yes 141 No <br /> Reason Sprinklers Required: "In Lieu" Fee:Type: Amount$ <br /> Fire Alarm: ❑Update Existing ❑New System ®Not Req'd School Impact Fee: Total $ <br /> Reason Fire Alarm Required: Calculated: 1 : <br /> RCW 64.55 MF worksheet req'd for permit? ❑Yes No 0 Everett School Dist Mukilteo School Dist <br /> Add'I RCW 64.55 docs required prior to final? ❑Yes riiNo Additional Notes: <br /> VALUATION CALCULATION: Total$#7,00,dO0,00 <br /> Approved By: .._1;7 ........_ Date: 2 Z.V. 201,,Ci <br /> PUBLIC WORKS <br /> Intake OK by: n k.1 Date: l I 1 .12-01 9 <br /> Additional Notes: Intake Comments: PW Worksheet Needed if: <br /> NI 5-tS -D 1:C.C...5 ❑Sys Dev Eval ❑Traffic Mit Eval <br /> N o N'-v-r "'A-NJ f►J Ca ❑Site Work or Drainage Proposed <br /> / ❑Backflow Prevention for high hazard: <br /> Approved By �� Date: d�vy �y Ccs.0— NS,v-5,o, ,4 o f Q•3wv'Pt.f ntal,medical,animals,mortuary,hospital, <br /> / _ -r '1%71-aq...Ex, supportive housing) <br /> FIRE DEPARTMENT '�=,"oute this folder for PW Review at end ---PW Review Worksheet <br /> Intake: (Needed for Townhomes,Alley load SFR,New Commercial) OThis project also has a separate concurrent PW Review(Green Folder) <br /> ❑Route to Fire Drawer---Fire Preliminary Review Notice AND ❑Create Green Folder ❑Submitted Previously ❑Deferred <br /> ❑Sending Fire Notes to Project Team 0 This Permit is Approved by Public Works <br /> Date: (OK to Route to Other Departments) 0 See PW Review Worksheet and associated attached items <br /> Fire Sprinklers: ❑Update Existing ❑New System JJ Not Req'd 0 A Separate PW Permit is Required (Permit#: PW ) <br /> Fire Alarm: ❑update Existing ❑New System ❑ Not Req'd AND 0 Is located in this folder <br /> Chemical Sup: ❑Update Existing ❑New System 6 Not Req'd 0 Is in a Separate Green Folder(join with this folder for permit issuance) <br /> Additional Notes: 1 r 0 Will be issued separately(Separate Green Folder,PW issued ahead of Bldg) <br /> �C <br /> Approved By: O¢�-c/( <br /> Date: I 15 Public Works has no scope PW Not Required <br /> A ditional Notes: <br /> ELECTRICAL <br /> Additional Notes: _ <br /> Approved By: Date: Approved By: Date: //2.3 O is <br />